Provider Demographics
NPI:1578000972
Name:ESTAPE GYNECOLOGIC ONCOLOGY, PLLC
Entity type:Organization
Organization Name:ESTAPE GYNECOLOGIC ONCOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-666-1811
Mailing Address - Street 1:8585 SUNSET DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3746
Mailing Address - Country:US
Mailing Address - Phone:305-666-1811
Mailing Address - Fax:305-666-1801
Practice Address - Street 1:8585 SUNSET DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3746
Practice Address - Country:US
Practice Address - Phone:305-666-1811
Practice Address - Fax:305-666-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65373207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251157600Medicaid
FLG43058Medicare UPIN